Midgut Volvulus CT

Discussion by Dr MGK Murthy, Dr Pritam, Dr GA PrasadIntestinal malrotation is described as abnormal positioning of the bowel loops within the peritoneal cavity in the intrauterine life. It is caused by defective rotation of primitive intestinal loop around the axis of SMA during embryogenesis.Midgut volvulus is a complication of malrotation in which clockwise twisting of the bowel around the superior mesenteric artery axis occurs because of the narrowed mesenteric attachment. Degree of twisting is variable& determines symptoms. Severe volvulus = 3& ½ turns, can lead to bowel necrosis.Age at presentation – usually neonate or young infant. Occasionally older child or adult.Associations  ( in 20%) --      Duodenal atresia.-      Duodenal web.-      Duodenal stenosis.-      Annular pancreas.Acute symptoms in new born (medical emergency) - bilious vomiting (intermittent / post prandial /projectile), abdominal distension, shock.Subacute obstruction with intermittent symptoms in older child – recurrent attacks of nausea, vomiting, pain abdomen.X ray– Dilated air filled duodenal bulb or double bubble sign with air – fluid levels in duodenum& stomach.Barium study– DJ junction located to the right. Spiral course of midgut loops (corkscrew appearance or apple peel or twisted ribbon appearance). Duodenal fold thickening& thumb printing (m...
Source: Sumer's Radiology Site - Category: Radiology Authors: Source Type: blogs